合并低三碘甲状腺原氨酸综合征对急性病毒性心肌炎患者不良心血管事件的影响  

Impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis

作　　者：赵妍 王文尧[1] 田间 张璇[1] 杨敏[1] 陈静[1] 牟牧 唐熠达[1] Zhao Yan;Wang Wenyao;Tian Jian;Zhang Xuan;Yang Min;Chen Jing;Mu Mu;Tang Yida(Department of Cardiology,Fuwai Hospital,Chinese Academy of Medical Sciences,National Center for Cardiovascular Diseases,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心,阜外医院心内科,100037

出　　处：《中华心血管病杂志》2019年第6期447-451,共5页Chinese Journal of Cardiology

基　　金：国家杰出青年科学基金(81825003);中国医学科学院医学与健康科技创新工程(2016-I2M-1-009);北京市科学技术委员会首都科技领军人才培养工程(Z181100006318005).

摘　　要：目的分析合并低三碘甲状腺原氨酸(T3)综合征对急性病毒性心肌炎患者不良心血管事件的影响。方法回顾性入选2002年1月至2018年3月阜外医院心内科住院的急性病毒性心肌炎患者134例,根据入院时的血清游离三碘甲状腺原氨酸(FT3)水平将入选者分为低T3组(n=20)和正常组T3(n=114)。收集入选者基本资料(年龄、性别、症状、生命体征)、入院心电图、实验室检查(甲状腺激素水平等)和经胸超声心动图参数[左心室射血分数(LVEF)等]等。将血清FT3、总T3减低,伴或不伴游离甲状腺激素(FT4)、总甲状腺激素减低,促甲状腺激素正常,定义为低T3综合征。复合不良心血管事件包括急性期死亡、持续性室性心动过速(室速)/心室颤动(室颤)或心脏停搏。通过logistic回归分析分析急性心肌炎患者发生复合不良心血管事件的危险因素。结果与正常T3组患者比较,低T3组患者就诊时收缩压更低(P<0.01)、心率更快(P=0.004)。低T3组患者发生持续性室速/室颤的比例高于正常T3组(P=0.017)。与正常T3组比较,低T3组患者白细胞计数、C反应蛋白及空腹血糖更高(P均<0.01)、血肌酐水平更高(P=0.035),FT3水平更低(P<0.01)。低T3组患者LVEF明显低于正常T3组(P<0.01)。logistic回归分析结果显示入院时LVEF<40%(OR=6.615,95%CI 1.186~36.907,P=0.031)、FT3<1.79 ng/L(OR=9.131,95%CI 1.577~52.857,P=0.014)是急性病毒性心肌炎患者发生不良心血管事件的独立危险因素。结论合并低T3综合征可能增加急性病毒性心肌炎患者不良心血管事件的风险。Objective To determine the impact of low T3 syndrome on adverse cardiovascular events in adult patients with acute viral myocarditis.Methods The study population consisted of 134 consecutive patients admitted between January 2002 and March 2018 with diagnoses of acute viral myocarditis (onset of symptoms<1 month,patients were divided into low serum free triiodothyronine (FT3,n=20) group and normal FT3 (n=114) group.General information,clinical presentation,electrocardiography at admission,laboratory tests,echocardiography features were analyzed.Low T3 syndrome was defined as a state with decreased FT3 and total triiodothyronine (TT3),normal or decreased free thyroxine (FT4) and total thyroxine (TT4) as well as normal thyroid stimulating hormone (TSH).Composite adverse cardiovascular events included death,persistent ventricular tachycardia (VT) or ventricular fibrillation (VF) and cardiac arrest.Risk factors related with composite adverse cardiovascular events in adult patients with acute viral myocarditis were analyzed by logistic regression analysis.Results Systolic blood pressure was significantly lower (P<0.01),while heart rate (P=0.004) and the prevalence of VT/VF were significantly higher (P=0.017) in low T3 group than in the normal T3 group.Level of white blood cell,C response protein,fasting glucose (all P<0.01) as well as creatinine (P=0.035) were significantly higher,while level of FT3 and left ventricular ejection fraction (LVEF) were significantly lower (both P<0.01) in low T3 group than in normal T3 group.Multivariate logistic regression analysis revealed that LVEF at admission less than 40%(OR=6.615,95%CI 1.186-36.907,P=0.031) and FT3 level less than 1.79 ng/L (OR=9.131,95%CI 1.577-52.857,P=0.014) were independent risk factors of increased composite adverse cardiovascular events in patients with acute viral myocarditis.Conclusion Low FT3 increases the risk of adverse cardiovascular events in adult patients with acute viral myocarditis.

关 键 词：心肌炎 功能正常甲状腺病综合征 不良心血管事件 

分 类 号：R542.21[医药卫生—心血管疾病] R581[医药卫生—内科学]